Clinical Profile and Outcome of Children Using Mechanical Insufflation Exsufflation Device (Cough Assist) at a Tertiary Care Hospital in Bangalore, India

Abstract

Abstract Background and Objective: Children with neuromuscular disorders (NMDs) face a higher risk of recurrent pneumonias. Mechanical insufflation–exsufflation (MI-E) is a technique designed to enhance cough effectiveness, improve mucus clearance, and ultimately enhance lung health by boosting expiratory airflow and cough peak flow in coordination with a cough. We assessed the safety and adverse effects of MI-E in our cohort. Materials and Methods: This retrospective study was conducted over a period of 1.5 years at a tertiary care hospital in Bangalore, South India. Children between 1 and 18 years of age were included in the study. The demographic details of each child were collected from hospital records, along with the indication for starting MI-E and the duration of usage of MI-E. Results: Thirty-three children (18 boys) were started on MI-E. The most common indication was spinomuscular atrophy. Before the start of MI-E, 30 children were on noninvasive ventilation and 13 had a tracheostomy. The median insufflation and exsufflation pressures used were in the range of +15 to 25 cm H2O and −15 to −25 cm H20, respectively. Auto mode was used in all the cases, and 28 children used it on a long-term basis. There was a decrease in the frequency of hospitalization (especially in children with NMD). Adherence was very good without any evidence of barotrauma or any other complications. Conclusions: We found that the MI-E device is a valuable tool for aiding airway clearance in children with NMDs. Its use not only prevents intensive care unit admissions, reducing hospital stay duration but many times mitigates the need for hospital admissions altogether.